Prosthetic Gait Deviations

Question 1

List some possible gait deviations that can be observed in TTA?

Answer 1

1. Excessive knee extension
2. Knee Instability
3. Hip drop
4. Lateral thrust
5. Wide based gait
6. Drop-off/Knee Instability
7. Vaulting
8. Pistoning
9. Uneven Step length
10. Circumduction

Question 2

List gait deviations that are observed in TTA during stance phase?

Answer 2

1. Excessive knee extension
2. Knee instability
3. Hip drop
4. Lateral thrust
5. Wide based gait
6. Drop off/knee instability

Question 3

describe the gait deviation excessive knee extension (TTA)

Answer 3

knee joint is fully extended at IC, and stays that way through early stance phase

observed in the sagittal plane

Question 4

what are some causes for the excessive knee extension gait deviation (TTA)

Answer 4

1. Prosthetic causes
   
   • socket aligned too far posterior/foot aligned too far anterior
   • heel too soft
   • insufficient socket flexion
2. Patient causes
   
   • weak musculature around knee
   • locking knee to prevent fall

Question 5

describe the gait deviation “knee instability” observed in TTA

Answer 5

knee joint appears unstable duringly early stance phase

view in sagittal plane

might notice shortened stance phase on prosthetic side during gait (don’t confuse this with drop-off)

looks like pt is stepping into a hole

Question 6

what are some causes of the gait deviation knee instability in TTA?

Answer 6

1. Prosthetic causes:
   
   • socket aligned too far anterior/foot aligned too far posterior
   • heel too firm
   • excessive foot DF
2. Patient causes
   
   • weak quads
   • knee flexion contracture

Question 7

describe the gait deviation hip drop observed in TTA

Answer 7

pelvic drop toward prosthetic side during MSt

view in frontal plane

might occur as a compensation to offload a painful area of the residual limb

Question 8

what are some causes of the gait deviation, hip drop, observed in TTA?

Answer 8

1. Prosthetic causes
   
   • prosthesis too short
2. Patient causes
   
   • residual limb pain

Question 9

describe the gait deviation Lateral Thrust, observed in TTA

Answer 9

narrow BOS with lateral thrust of the socket during MSt excessive varus thrust at knee

can be difficult to see - might look like compensated/uncompensated Trendelenburg

look at proximal pylon → will be lateral leaning

pt complains of proximal medial and distolateral skin breakdown/pain

Question 10

what are some causes of the gait deviation Lateral Thrust observed in TTA?

Answer 10

1. Prosthetic causes:
   
   • foot too far inset
   • laterally leaning pylon
2. Patient causes:
   
   • glute med weakness
   • knee ligament insufficiency

Question 11

what are some causes of the gait deviation Wide Based Gait observed in TTA?

Answer 11

1. Prosthetic causes:
   
   • outset foot
   • medial leaning pylon
2. Patient causes:
   
   • insufficient weight shift
   • hip abduction tightness
   • patient fear

Question 12

describe the gait deviation, drop-off/knee instability, observed in TTA

Answer 12

early and excessive knee flexion during TSt

pt appear to be falling off prosthetic at TSt and the knee looks like it buckles during the transition from TSt to ISw

non-prosthetic side might not achieve full IC/LR and instead have foot flat as they are “catching themselves”

Question 13

what are some causes of the gait deviation, drop-off/knee instability, observed in TTA?

Answer 13

1. Prosthetic causes:
   
   • socket aligned too far anterior/foot too far posterior
   • inappropriate foot choice
2. Patient causes:
   
   • knee flexion contracture

Question 14

List gait deviations that are observable during swing phase in TTA

Answer 14

1. Vaulting
2. Pistoning
3. Uneven step length
4. Circumduction

Question 15

describe the gait deviation, Vaulting, observed in TTA

Answer 15

excessive PF of sound limb during MSt to clear prosthetic foot

view in frontal plane

essentially doing a calf raise with every step

Question 16

what are some causes of the gait deviation, Vaulting, observed in TTA?

Answer 16

1. Prosthetic causes:
   
   • prosthesis too long
   • long toe lever arm
   • socket too far posterior
2. Patient causes:
   
   • holding knee in extension too long

Question 17

what is pistoning?

Answer 17

loss of suspension

viewed in sagittal plane (or any plane)

Question 18

what are some causes of pistoning?

Answer 18

1. Prosthetic causes:
   
   • socket too large
   • not enough socks
2. Patient causes:
   
   • volume changes (decrease in volume throughout the day)
   • not enough socks

Question 19

what are some causes for uneven step length in TTA?

Answer 19

insufficient gait training

decreased patient confidence

Question 20

describe the gait deviation, Circumduction, observed in TTA

Answer 20

pt swings leg around in abducted position to advance it forward

demonstrated more commonly in TFA

TTA tend to lock out knee making a functionally longer limb that is difficult to progress through gait

Question 21

what are some causes for the gait deviation, Circumduction, observed in TTA?

Answer 21

1. Prosthetic causes:
   
   • poor suspension
   • prosthesis too long
2. Patient causes:
   
   • feeling of instability
   • decreased knee flexion during swing

Question 22

What are some main takaways from the TTA gait deviation lecture?

Answer 22

1. any gait deviation is going to have an impact on gait efficiency and work
2. analyze gait from multiple viewpoints to catch deviations
3. patients may have a combo of deviations
4. recognize when a deviation is out of your control and refer appropriately
5. treat impairments when possible

Question 23

List gait deviations observed in TFA

Answer 23

1. Terminal Impact
2. Foot slap
3. Knee Instability
4. Lateral Trunk Bend
5. Abducted gait
6. Excessive Trunk Extension
7. Drop off
8. Excessive heel rise
9. Circumduction
10. Vaulting
11. Medial Whip
12. Lateral Whip

Question 24

describe the gait deviation, Terminal Impact, observed in TFA

Answer 24

forceful and excessive knee extension, usually audible

observed in sagittal plane

from IC/LR

Question 25

what are some causes for the gait deviation Terminal Impact (TFA)?

Answer 25

1. Prosthetic cause * inadequate knee friction 2. Patient cause * fear of knee giving way * forceful hip flexion

Question 26

describe the gait deviation, Foot Slap, observed in TFA

Answer 26

accelerated PF at heel strike resulting in the foot getting flat to the floor too soon IC/LR observed in sagittal plane

Question 27

what are some causes for the gait deviation Foot Slap (TFA)

Answer 27

1. Prosthetic causes: * PF bumper too soft 2. Patient causes * increased hip extension force at IC

Question 28

describe the gait deviation, knee instability, observed in TFA

Answer 28

knee giving way in early stance phase observed in IC/LR in sagittal plane

Question 29

what are some potential causes of the gait devitation, Knee Instability observed in TFA

Answer 29

1. Prosthetic causes * knee axis too far anterior * socket too far posterior * lack of socket flexion 2. Patient causes * inadequate hip extension ROM * hip flexion contracture

Question 30

what are some causes of the gait deviation lateral trunk bend observed in TFA?

Answer 30

1. Prosthetic causes * socket too abducted * prosthesis too short * medial socket wall too high 2. Patient causes * pain * glute med weakness * decreased balance * adductor roll

Question 31

describe the gait deviation, Lateral Trunk Bend, observed in TFA

Answer 31

excessive lateral lean during stance phase might have a decrease in contact with lateral wall of the socket which will decrease the ability of the glute to stabilize the pelvis observed in MSt, in frontal plane

Question 32

describe the gait deviation, abducted gait, observed in TFA

Answer 32

excessive hip abduction during stance leading to a wide based gait pattern observed in MSt in the frontal plane

Question 33

what are some causes of abducted gait?

Answer 33

1. Prosthetic causes * foot/leg too far outset * prosthesis too long * medial socket wall too high * lateral wall not adducted enough 2. Patient causes * abduction contracture * lateral-distal RL pain * decreased balance/trying to incr BOS * adductor roll

Question 34

describe the gait deviation, Excessive Trunk Extension, observed in TFA

Answer 34

excessive lumbar lordosis during stance or a posterior trunk lean observed in MSt in sagittal plane

Question 35

what are some causes of excessive trunk extension?

Answer 35

1. Prosthetic causes * increased socket extension * not enough flexion build into socket 2. Patient causes * weak hip extensors * weak abdominals * hip flexion contracture

Question 36

describe the gait deviation drop off (TFA)

Answer 36

sudden and excessive knee flexion during late stance phase observed in TSt in sagittal plane

Question 37

what are some causes of the gait deviation drop off?

Answer 37

1. Prosthetic causes * short toe lever * socket set too posterior to knee axis 2. Patient causes * N/A

Question 38

describe the gait deviation excessive heel raise (TFA)

Answer 38

prosthetic heel rises excessively (both in distance and velocity) observed in PSw → Sw in sagittal plane

Question 39

what are some causes for the gait deviation excessive heel raise?

Answer 39

1. Prosthetic causes: * insufficient knee friction 2. Patient causes: * early forceful hip flexion

Question 40

describe the gait deviation Circumduction (TFA)

Answer 40

user swings leg in a circular motion laterally to advance it during swing observed in Sw in frontal plane

Question 41

what are some potential causes of the gait deviation circumduction (TFA)?

Answer 41

1. Prosthetic cause * prosthesis too long * inadequate suspension * excessive knee friction 2. Patient cause * hip flexor weakness * hip abduction contracture * fear

Question 42

describe the gait deviation Vaulting observed in TFA

Answer 42

excessive PF of the sound limb to clear the prosthetic limb observed in Sw in frontal plane looks like they are doing a calf raise with every step

Question 43

what are some potential causes of the gait deviation: Vaulting

Answer 43

1. Prosthetic cause * Prosthesis too long * inadequate suspension * excessive knee friction 2. Patient cause * hip flexor weakness * hip abduction contracture * fear

Question 44

describe the gait deviation Medial Whip (TFA)

Answer 44

medially directed whipping motion of the prosthesis observed in Sw in frontal/transverse plane

Question 45

what are some potential causes of the gait deviation Medial Whipping?

Answer 45

1. Prosthetic causes * ER of knee compartment * improper alignment of knee bit 2. Patient causes * improper donning

Question 46

describe the gait deviation, Lateral Whip (TFA)

Answer 46

laterally directed whipping motion of the prosthesis observed in Sw in frontal/transverse plane

Question 47

what are some potential causes of the gait deviation Lateral Whip?

Answer 47

1. Prosthetic cause * IR of knee component * improper alignment of knee bit 2. Patient cause * improper donning

Question 48

What TFA gait deviations are observed in stance phase?

Answer 48

1. Terminal Impact 2. foot slap 3. knee instability 4. lateral trunk bend 5. abducted gait 6. excessive trunk extension 7. drop off 8. excessive heel raise

Question 49

what TFA gait deviations are observed in swing phase?

Answer 49

1. circumduction 2. vaulting 3. medial whip 4. lateral whip

Question 50

what is the relationship between # of prosthetic components and deviations?

Answer 50

more components = increased likelihood of deviations